Sunday, November 14, 2010

Weekend Rerun: Ideology and Health Care

Judging from recent elections returns, I think we can safely say that the Democrats shot themselves in the foot politically by spending most of the last two years on comprehensive health care reform. But I don't think you can argue that all the time we've spent disagreeing about health care policy changed the ideological terrain much. Liberals and conservative wonks spent a lot time arguing, inconclusively, about whether ObamaCare would really bend the cost curve, would really make it easier to balance the budget down the road, would really enable people to keep their insurance plans if they wanted to, etc. Yet when it comes to the powerful normative impulses that really drive the debate, liberals and conservatives were spectacularly successful at talking past each other. This post from March 25 (slightly edited) was an attempt to identify those impulses, and the ideological impasse they've generated, in terms that are intelligible to both sides:

All my political life, I’ve had trouble not giggling when I hear a conservative on a “road to serfdom” rant, portraying some modest social reform as a fateful step on the way to collectivist perdition. You know how they go: “Today liberal politicians want to fluoridate the water supply, tomorrow they’ll have you registering your toothbrush with the People’s Department of Hygiene, and the day after that you won’t even think it’s strange when you line up for two hours in the rotunda of the People’s Reeducation Center for your monthly provision of government-approved dental floss.”

You may think, along with Jonathan Cohn, that ObamaCare is “a major, but not a radical, reform” because it lacks a public option, a Medicare buy-in, etc. Yet a lot of conservatives, like Mark Steyn, think it’s the point of no return in the descent of free and independent citizens of a republic into perpetual adolescents tied to the apron strings of the nanny state:

“Government-directed health care is a profound assault on the concept of citizenship. It deforms national politics very quickly, and ensures that henceforth elections are always fought on the left’s terms. . . .

"If free citizens of the wealthiest societies in human history are not prepared to make provision for their own health, what other core responsibilities of functioning adulthood are they likely to forego? Oh, Smith and Jones can still be entrusted to make their own choices about which movie to rent from Netflix, or which breakfast cereal to eat. For the moment. But you’d be surprised how quickly the “right” to health care elides into the government’s right to tell you how to live in order to access that health care. A government-directed medical system can be used to justify almost any restraint on freedom: After all, if the state undertakes to cure you, it surely has an interest in preventing you needing treatment in the first place – or declining to treat you if you persist in your deviancy . . . ”

Before liberals start laughing too hard, they should notice that Steyn’s argument draws on the same considerations that generate the ethical impulse behind ObamaCare, viz., the idea that everyone has a right to affordable health care. Liberals think that follows from the fact that, under normal circumstances, preserving one’s life, maintaining one’s health and relieving one’s avoidable pain is a necessary condition of leading a life worth living. That’s why, when we encounter someone acting in reckless disregard for his own life, health and safety, say a suicidal person, we’re inclined to reach for a straitjacket until he either regains his composure or persuades us that his circumstances are sufficiently abnormal to justify his suicidal designs (perhaps he’s in unbearable pain, or reasonably believes that his dying will help save someone else’s life, etc.).

For liberals, these facts have compelling distributive implications. It’s a small step from acknowledging that reasonable people normally regard securing life and maintaining health as being incomparably more valuable than the things money can buy, to concluding that, as a matter of social justice, each person’s interest in securing those vital goods should take precedence over everyone else's interest in securing the less-than-vital satisfactions they could buy with their untaxed dollars. That’s what it means to say that people have a right to affordable health care.

Steyn is drawing jurisdictional consequences from the very same facts. If everyone’s interest in securing his own, or his family's life and health should take precedence over other people’s less-vital interests, how can anyone incur a political obligation to other people to surrender his right to make decisions that have a substantial impact on the realization of his own vital interests? The same considerations that make liberals believe that we all have a right to health care make conservatives think that it’s unreasonable for any individual to delegate decisions with life and death implications for him and his loved ones to government bureaucrats.

That’s what conservatives are getting at when they hyperventilate over “medical rationing” and “death panels.” Most of them don't harbor irrational fears that government bureaucrats wish them ill or will be less than diligent in promoting the greatest health for the greatest number of people. They’re worried about what giving those bureaucrats exclusive jurisdiction over decisions with life and death implications will mean for them in particular. It's not unreasonable for them to fear that circumstances may arise in which promoting everyone's health won't be consistent with promoting the health of the people that matter most to them.

Since the argument over health care reform has been continuing along these lines for seventy years, it's astonishing how oblivious each side is to the other's deepest concerns.